BSPED2013 Poster Presentations (1) (89 abstracts)
18F-DOPA PET and enhanced CT imaging for congenital hyperinsulinism: Our experience of using oral sedation
Pratik Shah 1 , Senthil Senniappan 1 , Marguerite du Preez 2 , Raymond Endozo 2 , Caroline Townsend 2 , Clare Gilbert 1 , Kate Morgan 1 , Louise Hinchey 1 , Agostino Pierro 1 , Lorenzo Biassoni 2 , Oystein Olsen 1 , Jamshed Bomanji 2 & Khalid Hussain 1
1Great Ormond Street Hospital NHS Foundation Trust, London, UK; 2University College London Hospital NHS Foundation Trust, London, UK.
Introduction: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in infants and children. Histologically there are two subgroups, diffuse and focal. Fluorine-18-L dihydroxyphenylalanine positron emission tomography (18F-DOPA PET/CT) helps to differentiate focal from diffuse CHI.
Objective and hypotheses: To evaluate the feasibility of using 18F-DOPA PET/CT for the diagnosis of focal or diffuse CHI under oral sedation. To look into the protocol of performing these images.
Methods: 27 18F-DOPA PET/CT and contrast enhanced CT imaging scans were performed on 22 consecutive patients with CHI (median age 2.1 years). All medications including octreotide and glucagon were discontinued 48 h before the scan. Single bed position PET/CT images over the pancreas were acquired under light sedation with oral chloral hydrate (dose 50 mg/kg). Four PET dynamic data scans were acquired at 20, 40, 50 and 60 min post injection for duration of 10 min each. Results were assessed by visual interpretation and quantitative measurements of standardized uptake values (SUVs) in the head, body and tail of the pancreas.
Results: Of the 22 patients, 16 showed diffuse and six showed focal 18F-DOPA PET pancreatic uptakes. Six patients had an accumulation of 18F-DOPA in the pancreas and a SUV ratio value of >1.5, indicating focal disease. The remaining 16 patients had diffuse accumulation of 18F- DOPA in the pancreas (SUV ratio <1.3). All the children tolerated oral sedation well. All patients diagnosed with focal lesions underwent surgery and were cured eventually.
Conclusion: 18F-DOPA PET/CT offers excellent differentiation of focal from diffuse CHI and enhanced CT technique permits precise preoperative localisation of the lesion and anatomical land-marks. Also, excellent qualities of images were obtained after giving oral sedation (chloral hydrate) in all children without need of general anaesthesia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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